Provider Demographics
NPI:1114026044
Name:RAINA WINFREY, MD, PC
Entity Type:Organization
Organization Name:RAINA WINFREY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-872-9808
Mailing Address - Street 1:716 DENBIGH BLVD
Mailing Address - Street 2:SUITE C-4
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4414
Mailing Address - Country:US
Mailing Address - Phone:757-872-9808
Mailing Address - Fax:757-872-9751
Practice Address - Street 1:716 DENBIGH BLVD
Practice Address - Street 2:SUITE C-4
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4414
Practice Address - Country:US
Practice Address - Phone:757-872-9808
Practice Address - Fax:757-872-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty